Functioning of patients at the early stage of schizophrenia

Background. Functional recovery of patients with schizophrenia (psychopharmacotherapy, psychotherapy, and so-cial rehabilitation) is a pressing goal of modern psychiatry. Identification of factors influencing patient functioning can improve the prognosis of the functional outcome of the disease using a scale for assessing the functional state and pre-dicting the outcome. Objective: to assess the functioning of patients at an early stage of schizophrenia and to identify factors influencing the functional outcome. The study was conducted at the clinical site of the Department of Psychiatry and Narcology of the Medical Institute of St. Petersburg State University. Materials and Methods. Patients (n=160) with paranoid schizophrenia (F20.0) in remission were examined. The total sample was divided into two groups: the main group consisted of patients (n=160) with the first episode (up to 5 years of disease progression, no more than 3 attacks), and the comparison group consisted of patients (n=80) with the disease duration of more than 5 years. Patients’ functioning (study/work, family, education, health, availability of support from relatives and social services) was as-sessed using the Personal and Social Performance Scale (PSP) and the Global Assessment of Functioning (GAF). Re-sults. Patients at the early stage of schizophrenia had a statistically significantly (p<0.05) higher level of social function-ing compared to long-term ill patients (70.5±10.81 and 50.67±6.90 points on the PSP; 82.5±9.71 and 63.81±7.90 points on the GAF). Statistically significant (p<0.05) differences in social functioning were found between patients in the com-pared groups with different disease durations (4.6±0.85 points and 2.6±0.96 points on the PSP scale). In the main and comparison groups, statistically significantly (p<0.05) higher total PSP scores were found in female patients compared to male patients (in patients with the first psychotic episode ‒ 76.1±9.79 and 61.21±6.75 points, in long-term patients ‒ 53.68±7.94 and 49.85±6.54 points). The level of functioning at the early stage of schizophrenia was higher in patients who did not have a disability due to mental illness, who received higher education, and were employed. Results of mul-tiple linear regression demonstrated that a favorable functional outcome with preservation/restoration of the level of so-cial functioning was influenced by the later age of disease onset (β=-0.86, p<0.01), the female sex (β=3.25, p<0.05), the absence of neurological side effects of therapy (β=-0.84, p<0.05), living with their own family (β=3.11, p<0.05), having higher education (β=8.91, p<0.001), maintaining employment status (β=1.29, p<0.05), the absence of disability (β=5.71, p<0.01), lesser severity of cognitive impairment (β=-0.295, p=0.01) and negative symptoms (β=-1.869, p<0.001). Con-clusions. Female patients have been shown to have higher levels of personal and social functioning than males, regard-less of the disease stage. The most significant differences between patients in the early and chronic stages of the disease concern the domain of socially useful activity. The functional outcome of schizophrenia is the result of the influence of diverse factors, requiring the integration of psychopharmacological and psychosocial approaches.